HHS Officials Meet with Health Insurers on Prior Authorization

Robert F. Kennedy, Jr., secretary of the U.S. Department of Health and Human Services, and Mehmet Oz, MD, MBA, administrator of the Centers for Medicare and Medicaid Services, hosted a roundtable discussion with health insurance industry leaders June 23, to discuss longstanding issues with the industry’s prior authorization process.

Executives from Aetna, Inc., America’s Health Insurance Plans, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Inc., Kaiser Permanente, and UnitedHealthcare pledged during the meeting to, “streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace® and commercial plans covering nearly eight out of 10 Americans.”

The insurers pledged to take actions including standardizing electronic prior authorization submissions, reducing the volume of medical services subject to prior authorization, honoring existing authorizations during insurance transitions to ensure continuity of care, enhancing transparency and communication around authorization decisions and appeals, expanding real-time responses to minimize delays in care, and ensuring medical professionals review all clinical denials.

The initiative to streamline and improve prior authorization aligns with American College of Radiology^® (ACR^®)-supported legislation introduced in Congress — the Seniors’ Timely Access to Care Act of 2025 (H.R. 3514/S. 1816) — that would establish into law several related requirements and standards within the Medicare Advantage program.

ACR encourages Congress to pass this legislation and other legislation to reduce patient wait times and ensure patients receive the right care at the right time, such as the Radiology Outpatient Ordering Transmission (ROOT) Act (S.1692). The ROOT Act aligns with the objectives of prior authorization reform; it also would require providers to consult physician-developed appropriate use criteria (AUC) when ordering advanced diagnostic imaging for Medicare beneficiaries. The use of AUC as an educational tool at the point of order would reduce the volume of unnecessary imaging, enhance transparency and communication about the use of imaging services, and provide real time feedback for ordering providers and patients, while simultaneously providing savings to both the Medicare system and the patient

For more information or if you have questions about prior authorization issues, contact Katie Keysor, ACR Senior Director, Economics and Health Policy.